期刊
CURRENT OPINION IN RHEUMATOLOGY
卷 28, 期 6, 页码 619-624出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BOR.0000000000000335
关键词
autoantibody; autoimmunity; 3-hydroxy-3-methylglutaryl-CoA reductase; immune-mediated necrotizing myopathy; myositis; signal recognition particle
类别
资金
- National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health
Purpose of reviewThis review aims to describe the spectrum of clinical, histological, and serological features in patients with immune-mediated necrotizing myopathies (IMNMs).Recent findingsAutoantibodies recognizing the signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) define two unique subtypes of necrotizing myositis patient with distinct clinical features. For example, the major histocompatibility class II human leukocyte antigen allele DRB111:01 is a strong immunogenetic risk factor for developing anti-HMGCR autoantibodies whereas B5001 and DQA10104 are over-represented in patients with anti-SRP autoantibodies. Furthermore, statin exposure is a risk factor only for anti-HMGCR autoantibodies. And while skeletal muscle involvement is predominant in most patients with both autoantibodies, lung involvement appears in approximate to 20% of anti-SRP-positive patients but is more rare in anti-HMGCR-positive patients. Of note, approximate to 20% of anti-SRP and anti-HMGCR positive patients have significant lymphocytic infiltrates on muscle biopsy and thus would not be formally categorized as having IMNM; aside from this, these patients are clinically indistinguishable from other patients with the same autoantibody profile.SummaryAnti-SRP and anti-HMGCR autoantibodies define unique populations of IMNM patients. It may be more appropriate to subtype myositis patients based on these autoantibodies than on their muscle biopsy features.
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